<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Change_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-change_type" class="form-control selectpicker" name="row[change_type]">
                {foreach name="changeTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Merchant_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-merchant_id" data-rule="required" min="0" data-source="mycurrency/merchant/index" class="form-control selectpage" name="row[merchant_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Store_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-store_id" data-rule="required" data-source="mycurrency/merchant/store/index" class="form-control selectpage" name="row[store_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-money" data-rule="required" class="form-control" step="0.01" name="row[money]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Witserpro')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-witserpro" class="form-control" step="0.0001" name="row[witserpro]" type="number" value="0.0000">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Service_charge')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-service_charge" class="form-control" step="0.01" name="row[service_charge]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Actual_payment')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-actual_payment" class="form-control" step="0.01" name="row[actual_payment]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Payment_mode')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-payment_mode" class="form-control selectpicker" name="row[payment_mode]">
                {foreach name="paymentModeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_number" class="form-control" name="row[bank_number]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_opening')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_opening" class="form-control" name="row[bank_opening]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_account')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_account" class="form-control" name="row[bank_account]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Explain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-explain" class="form-control" name="row[explain]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="1"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Cancellation_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-cancellation_type" class="form-control selectpicker" name="row[cancellation_type]">
                {foreach name="cancellationTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Operation_explain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-operation_explain" class="form-control" name="row[operation_explain]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Offline_explain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-offline_explain" class="form-control" name="row[offline_explain]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Offline_credential_images')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-offline_credential_images" class="form-control" size="50" name="row[offline_credential_images]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-offline_credential_images" class="btn btn-danger faupload" data-input-id="c-offline_credential_images" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="true" data-preview-id="p-offline_credential_images"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-offline_credential_images" class="btn btn-primary fachoose" data-input-id="c-offline_credential_images" data-mimetype="image/*" data-multiple="true"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-offline_credential_images"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-offline_credential_images"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Applytime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-applytime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[applytime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rejecttime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rejecttime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[rejecttime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Toexaminttime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-toexaminttime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[toexaminttime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Paymenttime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-paymenttime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[paymenttime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
